Welcome to the Online Eligibility Questionnaire.

GrantAbility.com has developed a unique online process that eliminates the guess work from your government grant search and gives you instant results, providing you with a detailed report on the best matching government grants and/or financial assistance programs that you qualify for right now.

This service is currently available to businesses, organizations, groups and individuals.

PART ONE - Applicant details >> Create your profile

Instructions

To begin, complete the following questionnaire as thoroughly and accurately as possible, answering all the questions that apply to you. The more detailed the information you enter, the more you will benefit from the results of your search.

This questionnaire will require between 10-20 minutes of your time to complete.

Make sure to answer all the questions correctly and completely as they apply to you. The more details you can provide will allow us to do a more comprehensive search for all the programs you qualify for. When you have completed the questionnaire, click the 'Continue' button at the bottom of the page.

Also make sure to complete the required fields, indicated by an asterisks (*)

Section 1 - Basic Information

• 1. First Name *
   
• Last Name *
   
• 2. Gender * Male Female
   
• 3. Date of Birth DAY01020304050607080910111213141516171819202122232425262728293031 / MONTHJANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC / YEARAfter 199019901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Before 1920
   
• 4. Citizenship * US CitizenUS NationalLegal AlienPermanent ResidentOther
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.
a. If you indicated that your Citizenship is "Other" - explain. *
 
   

• 5. Street Address
   
• 6. City *
   
• 7. State or US Territory * AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingOther
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.
a. If you indicated your state is "Other" - explain. *
 
   

• 8. Zip Code
   
• 9. Geographic Area: Do you reside in a: *
    Country (Rural) area? City (Urban) area?
   
• 10. Primary Phone Number * ()-
   
•   Secondary Phone Number ()-
   
• 11. Email Address *
   

Section 2 - Cultural Background

• 1. What is your ethnicity / race? * African AmericanAmerasianAsian other than AmerasianCaucasianCubanHaitianHispanic other than CubanNative Pacific IslanderNative AmericanOther
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.
a. If you indicated your ethnicity as "Other" - explain *
 
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. Are you enrolled in a federally recognized American Indian  tribe or Alaskan native village? Yes No
• b. Do you currently lived or have you lived on an Indian reservation or  in an Alaskan native village? Yes No

 

Section 3 - Disability & Illness Details

• 1. Are you disabled or have a disability? * Yes No
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. From what age have you had this disability?
   
• b. What is that nature of the disability?
   
   
• c. Does this condition prevent you from:
    (check all that apply)
    Functioning independently in the family or community
    Holding a job (full-time or part-time)
• d. Are you in need of:
    (check all that apply)
    Adaptive equipment for disabilities
    Prosthetic aid (such as an artificial limb, braces, orthopedic shoes or wheelchair)
    Training or retraining to develop new job skills
• e. Was your injury or illness caused by:
    (check all that apply)
    Pneumoconiosis (black lung disease)
    Exposure to radiation, beryllium, or silica while working with the department of energy.
    Result of a vaccine
    Work or employment related
    Terrorist-related aircraft crashes on September 11, 2001

 

• 2. Do you, or any member of your family have any of the following conditions:
    (check all that apply)
    Blindness
    Hereditary blood disorder
    Drug or alcohol dependency
    HIV or AIDS
    Limb differences (other than limb loss)
    Limb loss
    Mental illness
    Paralysis (partial or complete)
    Permanently (rated 100%) disabled from a military service-connected condition pregnancy
    End-stage renal disease (permanent kidney failure requiring dialysis or a transplant)
    Spina bifida (not including spina bifida occulta)
• 3. Are any of the following members of your family deceased?
   (check all that apply)
    Child
    Parent
    Spouse
    Other

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. What was the cause of death for the above decedents?
    (check all that apply)
    While serving in active duty in the military
    Terrorist-related aircraft crashes on September 11, 2001
    As a result of a military service-connected disability or injury
• b. If none of the options in above apply, please specify the cause of  death for each person.
  
• c. Did the deceased work as any of the following:
    (check all that apply)
    Coal miner
    Employee of the department of energy (or it's predecessor agencies, contractors, or subcontractors)
    Federal employee
    Long shore or harbor worker
• d. Did the person die as a result of a work-related injury? Yes No

 

Section 4 - Military & Veteran Details

• 1. Are you a Veteran or currently active in the military? * Yes No
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. What is your current military status? ActivePreviously activeReserveVeteranOther
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.
A. If you selected your military status as "Other" - explain.
 
   

• b. On what date did you begin your military service? DAY01020304050607080910111213141516171819202122232425262728293031 / MONTHJANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC / YEAR20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Before 1920
• c. Did you decline the GI bill at the beginning of your military service? Yes No
• d. Have you completed 24 months of military service to date? Yes No
• e. On what date were you discharged or are you scheduled to be discharged from military service? DAY01020304050607080910111213141516171819202122232425262728293031 / MONTHJANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC / YEARAfter 2015201520142012201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Before 1920
   
• f. What was your status when you were discharged? Not ApplicableDishonorableGeneralHonorable
   
• g. If you are a veteran, did you serve on active duty in:
    (check all that apply)
    Afghanistan campaign
    Bosnia campaign
    Grenada campaign
    Gulf war
    Korean war
    Kosovo campaign
    Iraq second war
    Lebanon campaign
    Panama campaign
    Somalia campaign
    Vietnam war
    World war II
• h. Have you served in any of the following areas in the military:
    (check all that apply)
    Service member on active duty or ready reservists
    Commissioned corps of the national oceanic and atmospheric administration
    A midshipman of the four service academies
    Individual read reserve or the inactive national guard
    Reserve office training corps
    The regular or reserve corps of the public health service
• i. Were you involved in any of the following during military service:
    (check all that apply)
    Atmospheric detonation of a nuclear device or other radiation risk activities
    Test, transport or spray herbicides for military purposes
    NP radium treatment
• j. Did you have a 6 year obligation to serve in the reserve or national guard during the last 10 years? Yes No
• k. Did you serve at least 90 days with at least 1 day during a period of wartime? Yes No
• l. Were you held as a prisoner of war? Yes No

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

A. Were you a POW for more than 90 days? Yes No

 

• m. Do you (or did you) have a military service-connected disability, disease or injury? Yes No

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• A. Did your non-compensable condition or disability result from combat wounds or service trauma? Yes No
• B. Are you permanently and totally disabled as a result of an injury sustained in the line of duty? Yes No

 

• n. Are you receiving or in need of veteran's assistance or medical care? Yes No

 

 
• 2. Do you have a child with a birth defect related to his or her parents' military service in Vietnam? Yes No
• 3. Are you the spouse or a surviving dependant of a veteran (alive or deceased)? Yes No

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. Was the decease veteran entitled to or receiving Veterans' affairs pension or compensation? Yes No
• b. Have you been reimbursed by another government agency or other source for the funeral/burial expenses for the deceased veteran?
    Yes No

 

Section 5 - Family Situation

• 1. How many Members of your family reside with you? None12345678910Over 10
   
• 2. What is your current marital status? SingleMarriedDivorcedRemarriedWidow(er)
• 3. Are you a parent or primary care giver? Yes No

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. What is your parental or care giving situation?
    (check all that apply)
    Adoptive parent
    Foster care giver
    Child has special needs
    Have custody of a child with the other parent living outside the home or unknown
    Need help collecting child support
    Need help paying for child care
    Need help paying child support that I owe
    Need help to ensure child is not separated from my home
    Responsible for a child experiencing developmental delays  (cognitive, physical, communication, social, emotional)

 

• 4. Is anyone in your household, including yourself, receiving benefits from:
    (check all that apply)
    Vocational re-hab training
    Veterans' group life insurance
    Veterans' disability compensation
    Unemployment benefits
    Temporary assistance for needy families
    Social security
    National service life insurance
    Supplemental security income
    MSP- Qualifying Individual (QI)
    Social Security Disability (received for 2 years or less)
    Social Security Disability (received for 2 years or more)
    Railroad retirement (received for less than 2 years)
    Railroad retirement (received for 2 years or more)
    Medicare
    Medicaid
    Government service life insurance
    Service members' group life insurance
    United states government life insurance
    DOD tricare (formerly CHAMPUS)
    Specially adapted housing grant
    Food stamps
    MSP-Qualified medicare beneficiary (QMB)
    MSP-Specified low-income medicare beneficiary (SLMB)
    Low income home energy assistance program
    Senior community service employment program
    Unsure

Section 6 - Employment Situation

• 1. What is your current employment status? Employed Full timeEmployed Part TimeUnderemployedUnemployedStudentOther
   

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. How many months have you been unemployed?
   
• b. Are you able and willing to start work immediately? Yes No
• c. What is the reason for your current or impending unemployment?
    (check all that apply)
    Current conditions make it unlikely for me to return to my previous  occupation or industry
    General declining economic conditions
    The goods we manufactured are now being imported
    Job loss because employer is shifting production to or importing goods we previously manufactured  from Canada or Mexico
    Results of major disaster (as declared by the president)

 

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.
a. If you indicated "Other" as your employment status - explain.
   

 
• 2. Are you currently or have you previously been employed by any of the following?
    (check all that apply)
    An accredited health professions school
    College or university
    Department of energy (or its predecessor agencies, vendors, contractors, or subcontractors)
    Federal government agency (other than the military)
    National Institutes of health
• 3. Describe your current and past professional experiences. Check all that apply.
    Agricultural producer or farmer
    Aquaculture operator
    Clinical research
    Coal miner
    Dairy farmer
    Educator (teaching, training)
    Elected official
    Emergency response worker
    Federal employee (other than military)
    Firefighter
    Fisherman
    Health care professional
    Law enforcement officer
    Long shore or harbor worker
    Migrant or seasonal farm worker
    Military
    Musician
    Post-doctoral research
    Practicing artist
    Published writer / poet
    Railroad worker
    Rancher
    Translator
    Other

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.
a. Are you qualified, certified, or licensed for any of the following?
  DentistryFamily MedicineGeriatric MedicineInternal MedicineLaboratory or Clinical ResearchNurse or Nurse AnaesthetistPsychiatry 

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.
a. If you selected other you selected "Other" for professional experience - explain.
   

• 4. How many years of experience do you have in your current profession? 0-6 Months6 Months to 1 Year1 Year to 2 Years2 Years to 5 YearsOver 5 YearsOver 10 Years
• 5. Are you and every person in your household authorized to work in the United States? Yes No

Section 7 - Financial Situation

• 1. What is your household's annual income before taxes?
    Combine your income with that of every working person residing with you.
   
   
 
• 2. Did you, or your spouse, pay US Social Security Taxes?
    (check all that apply)
    Self Spouse No
• 3. Did you, or your spouse, pay social security or FICA taxes?
    (check all that apply)
    Self Spouse No
• 4. Do you have any debt (including Education Loans, Mortgages, & Past Due Taxes)? Yes No

ANSWER THE FOLLOWING QUESTION(S) TO PROVIDE MORE DETAIL.

• a. Do you (or any other person residing with you) have debts in the following areas?
    (check all that apply)
    Education loans (even if current)
    Housing debt or mortgage (even if current)
    Past due federal taxes
• b. What is the total amount of debts that you currently owe?
• c. What is your current amount of Credit Card debt?
• d. Have you Consolidated your debt? Yes No
• e. Are you interested in joining a debt management or settlement program? Yes No

f. I consent to being contacted by a debt management or settlement program representative.  

 

• 5. Have you ever been denied a loan by any of the following?
    (check all that apply)
    Commercial lender
    Small business association
• 6. Which of the following describes your household's sources of income?
    (check all that apply)
    Lost the majority of income due to an employer or business closure by a government agency or a disaster
    Receiving at least 50% support from a child who has died
    Previously supported by a person who died as a result of a disaster (as declared by the president)
    Dependant on the income of another family member, but no longer supported by that income
    Receiving 50% or more support from parents
• 7. Are you receiving prescription drug benefits from an Employer or retiree health insurance? Yes No